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Exercise echocardiographic comparison of pulmonary autograft and aortic homograft replacements for aortic valve disease in adults.

Publication ,  Journal Article
Wang, A; Jaggers, J; Ungerleider, RM; Lim, CS; Ryan, T
Published in: J Heart Valve Dis
March 2003

BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft, or Ross procedure, has theoretical hemodynamic benefits over other aortic valve replacements. The hemodynamic performance of the pulmonary autograft and pulmonary homograft components of this procedure have not been well defined. METHODS: Twenty patients with pulmonary autograft replacement of the aortic valve and six with aortic homografts underwent exercise echocardiography with assessment of exercise duration, left ventricular dimensions, mass, and function. Hemodynamics at rest and maximal exercise, including Doppler gradients and effective orifice area (EOA), were measured across the pulmonary autograft and aortic homograft valves. Doppler gradients across the pulmonary homograft valves were compared to native pulmonary valve gradients at rest and maximal exercise. RESULTS: Both groups of patients had excellent self-reported and measured exercise capacity. In comparison to the aortic homograft, the pulmonary autograft had lower peak Doppler gradients across the neoaortic valve at rest (5 +/- 2 versus 11 +/- 4 mmHg; p = 0.027) and maximal exercise (10 +/- 5 versus 15 +/- 5 mmHg; p = 0.003) and larger indexed EOA. However, the Ross procedure patients had higher gradients across the pulmonary homograft both at rest (14 +/- 10 versus 3 +/- 1 mmHg; p < 0.001) and maximal exercise (25 +/- 22 versus 5 +/- 4 mmHg; p = 0.004). Two patients in the Ross procedure group had significant pulmonary homograft stenosis in short- or mid-term follow up. CONCLUSION: In comparison to aortic homograft replacement of the aortic valve, pulmonary autograft replacement has superior hemodynamics at rest and during exercise. However, the pulmonary homograft replacement may develop hemodynamically significant stenosis after the Ross procedure.

Duke Scholars

Published In

J Heart Valve Dis

ISSN

0966-8519

Publication Date

March 2003

Volume

12

Issue

2

Start / End Page

202 / 208

Location

England

Related Subject Headings

  • Transplantation, Homologous
  • Transplantation, Autologous
  • Time Factors
  • Stroke Volume
  • Severity of Illness Index
  • Rest
  • Respiratory System
  • Pulmonary Valve
  • Pulmonary Artery
  • Prevalence
 

Citation

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MLA
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Wang, A., Jaggers, J., Ungerleider, R. M., Lim, C. S., & Ryan, T. (2003). Exercise echocardiographic comparison of pulmonary autograft and aortic homograft replacements for aortic valve disease in adults. J Heart Valve Dis, 12(2), 202–208.
Wang, Andrew, James Jaggers, Ross M. Ungerleider, Chang S. Lim, and Thomas Ryan. “Exercise echocardiographic comparison of pulmonary autograft and aortic homograft replacements for aortic valve disease in adults.J Heart Valve Dis 12, no. 2 (March 2003): 202–8.
Wang A, Jaggers J, Ungerleider RM, Lim CS, Ryan T. Exercise echocardiographic comparison of pulmonary autograft and aortic homograft replacements for aortic valve disease in adults. J Heart Valve Dis. 2003 Mar;12(2):202–8.
Wang, Andrew, et al. “Exercise echocardiographic comparison of pulmonary autograft and aortic homograft replacements for aortic valve disease in adults.J Heart Valve Dis, vol. 12, no. 2, Mar. 2003, pp. 202–08.
Wang A, Jaggers J, Ungerleider RM, Lim CS, Ryan T. Exercise echocardiographic comparison of pulmonary autograft and aortic homograft replacements for aortic valve disease in adults. J Heart Valve Dis. 2003 Mar;12(2):202–208.

Published In

J Heart Valve Dis

ISSN

0966-8519

Publication Date

March 2003

Volume

12

Issue

2

Start / End Page

202 / 208

Location

England

Related Subject Headings

  • Transplantation, Homologous
  • Transplantation, Autologous
  • Time Factors
  • Stroke Volume
  • Severity of Illness Index
  • Rest
  • Respiratory System
  • Pulmonary Valve
  • Pulmonary Artery
  • Prevalence